Vascular access is a commonly performed procedure to facilitate patient care. This document provides expert consensus from diverse specialists on best practices and techniques for incorporating ultrasound (US) into vascular access procedures. This update replaces the 2011 American Society of Echocardiography guidelines for US-guided vascular cannulation. It includes recommendations for US-guided access to central and peripheral veins and arteries in adult and pediatric patients based on the strength of the scientific evidence present in the literature. The major roles of US during vascular access include (1) precannulation vessel assessment, (2) dynamic US guidance during cannulation, and (3) identification of local complications. This document discusses the general aspects of anatomic and US imaging of vessels, US-guided vascular cannulation techniques, and the identification of local vascular cannulation complications. Proper training should impart the cognitive knowledge and technical skills necessary to perform US-guided cannulation. There is an increasing body of literature indicating that US-guided vascular access improves success rates and reduces complications, although the quality of the evidence to date remains weak. A gap remains between the existing evidence and guidelines for the use of US in clinical practice. The availability of US equipment and clinical proficiency will more likely influence the role of US-guided vascular access as a standard of care than will future research studies. (J Am Soc Echocardiogr 2025;38:57-91.)

血管通路建立是一项常用于辅助患者诊疗的操作。本文件汇集了多学科专家的共识，阐述了将超声（US）整合到血管通路操作中的最佳实践和技术。本更新版替代了2011年美国超声心动图学会发布的《超声引导血管插管指南》，其中包含基于文献中科学证据强度提出的建议，涉及成人和儿童患者中心及外周动静脉的超声引导通路建立。

超声在血管通路操作中的主要作用包括：（1）插管前血管评估；（2）插管过程中的实时超声引导；（3）识别局部并发症。本文件探讨了血管的解剖学及超声影像学的一般特征、超声引导血管插管技术，以及血管插管局部并发症的识别。规范培训应使操作者掌握实施超声引导插管所需的理论知识和技术技能。

越来越多的文献表明，超声引导血管通路建立可提高操作成功率并减少并发症，尽管迄今为止相关证据的质量仍较弱。在临床实践中，超声应用的现有证据与指南之间仍存在差距。相比未来的研究，超声设备的可及性及临床操作熟练度更可能影响超声引导血管通路建立成为标准诊疗手段的进程。（《美国超声心动图学会杂志》2025年；38卷：57-91页）